- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.10 / $117.19 / $145.35
| Professional | | $98.10 | $117.19 | $145.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.29 / $140.34 / $184.07
| Professional | | $105.29 | $140.34 | $184.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.64 / $157.91 / $220.28
| Professional | | $110.64 | $157.91 | $220.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.72 / $159.76 / $1,060.00
| Professional | | $120.72 | $159.76 | $1,060.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.35 / $145.44 / $208.70
| Professional | | $116.35 | $145.44 | $208.70 |